Narcissistic personality disorder

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Definition

Narcissistic personality disorder is a mental disorder in which people have an inflated sense of their own importance and a deep need for admiration. Those with narcissistic personality disorder believe that they're superior to others and have little regard for other people's feelings. But behind this mask of ultra-confidence lies a fragile self-esteem, vulnerable to the slightest criticism.

Narcissistic personality disorder is one of several types of personality disorders. Personality disorders are conditions in which people have traits that cause them to feel and behave in socially distressing ways, limiting their ability to function in relationships and in other areas of their life, such as work or school.

Symptoms

Narcissistic personality disorder is characterized by dramatic, emotional behavior, which is in the same category as antisocial and borderline personality disorders.

Narcissistic personality disorder symptoms may include:

Believing that you're better than others

Fantasizing about power, success and attractiveness

Exaggerating your achievements or talents

Expecting constant praise and admiration

Believing that you're special and acting accordingly

Failing to recognize other people's emotions and feelings

Expecting others to go along with your ideas and plans

Taking advantage of others

Expressing disdain for those you feel are inferior

Being jealous of others

Believing that others are jealous of you

Trouble keeping healthy relationships

Setting unrealistic goals

Being easily hurt and rejected

Having a fragile self-esteem

Appearing as tough-minded or unemotional

Although some features of narcissistic personality disorder may seem like having confidence or strong self-esteem, it's not the same. Narcissistic personality disorder crosses the border of healthy confidence and self-esteem into thinking so highly of yourself that you put yourself on a pedestal. In contrast, people who have healthy confidence and self-esteem don't value themselves more than they value others.

When you have narcissistic personality disorder, you may come across as conceited, boastful or pretentious. You often monopolize conversations. You may belittle or look down on people you perceive as inferior. You may have a sense of entitlement. And when you don't receive the special treatment to which you feel entitled, you may become very impatient or angry. You may insist on having "the best" of everything — the best car, athletic club, medical care or social circles, for instance.

But underneath all this behavior often lies a fragile self-esteem. You have trouble handling anything that may be perceived as criticism. You may have a sense of secret shame and humiliation. And in order to make yourself feel better, you may react with rage or contempt and efforts to belittle the other person to make yourself appear better.

When to see a doctorWhen you have narcissistic personality disorder, you may not want to think that anything could be wrong — doing so wouldn't fit with your self-image of power and perfection. But by definition, a narcissistic personality disorder causes problems in many areas of your life, such as relationships, work, school or your financial affairs. You may be generally unhappy and confused by a mix of seemingly contradictory emotions. Others may not enjoy being around you, and you may find your relationships unfulfilling.

If you notice any of these problems in your life, consider reaching out to a trusted doctor or mental health provider. Getting the right treatment can help make your life more rewarding and enjoyable.

Causes

It's not known what causes narcissistic personality disorder. As with other mental disorders, the cause is likely complex. The cause may be linked to a dysfunctional childhood, such as excessive pampering, extremely high expectations, abuse or neglect. It's also possible that genetics or psychobiology — the connection between the brain and behavior and thinking — plays a role in the development of narcissistic personality disorder.

Risk factors

Narcissistic personality disorder is rare. It affects more men than women. Narcissistic personality disorder often begins in early adulthood. Although some adolescents may seem to have traits of narcissism, this may simply be typical of the age and doesn't mean they'll go on to develop narcissistic personality disorder.

Although the cause of narcissistic personality disorder isn't known, some researchers think that extreme parenting behaviors, such as neglect or excessive indulgent praise, may be partially responsible.

Risk factors for narcissistic personality disorder may include:

Parental disdain for fears and needs expressed during childhood

Lack of affection and praise during childhood

Neglect and emotional abuse in childhood

Excessive praise and overindulgence

Unpredictable or unreliable caregiving from parents

Learning manipulative behaviors from parents

Children who learn from their parents that vulnerability is unacceptable may lose their ability to empathize with others' needs. They may also mask their emotional needs with grandiose, egotistical behavior that's calculated to make them seem emotionally "bulletproof."

Preparing for your appointment

People with narcissistic personality disorder are most likely to seek treatment when they develop symptoms of depression — often because of perceived criticisms or rejections. If you recognize that aspects of your personality are common to narcissistic personality disorder or you're feeling overwhelmed by sadness, talk with your doctor. Whatever your diagnosis, your symptoms signal a need for medical care.

When you call to make an appointment, your doctor may immediately refer you to a mental health provider, such as a psychiatrist.

Use the information below to prepare for your first appointment and learn what to expect from the mental health provider.

What you can do

Write down any symptoms you're experiencing and for how long. It will help the mental health provider to know what kinds of events are likely to make you feel angry or defeated.

Write down key personal information, including traumatic events in your past and any current, major stressors.

Make a list of your medical information, including other physical or mental health conditions with which you've been diagnosed. Also write down the names of any medications or supplements you're taking.

Take a family member or friend along, if possible. Someone who has known you for a long time may be able to ask questions or share information with the mental health provider that you don't mention.

Write down questions to ask your mental health provider in advance so that you can make the most of your appointment.

I have these other health conditions. How can I best manage them together?

Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

In addition to the questions that you've prepared to ask your mental health provider, don't hesitate to ask any additional questions that may come up during your appointment.

What to expect from your mental health providerThe mental health provider is likely to ask you a number of questions to gain an understanding of your symptoms and how they're affecting your life. The mental health provider may ask:

What are your symptoms?

When do these symptoms occur, and how long do they last?

How do you feel — and act — when others seem to criticize or reject you?

Do you have any close personal relationships? If not, how do you explain that lack?

What are your accomplishments?

What do you plan to accomplish in the future?

How do you feel when someone needs your help?

How do you feel when someone expresses difficult feelings, such as fear or sadness, to you?

How would you describe your childhood, including your relationship with your parents?

How would you say your symptoms are affecting your life, including school, work and personal relationships?

Have any of your close relatives been diagnosed with a mental health problem, including a personality disorder?

Have you been treated for any other mental health problems? If yes, what treatments were most effective?

Tests and diagnosis

Narcissistic personality disorder is diagnosed based on signs and symptoms, as well as a thorough psychological evaluation that may include filling out questionnaires.

Although there's no laboratory test to diagnose narcissistic personality disorder, you may also have a physical exam to make sure you don't have a physical problem causing your symptoms.

Some features of narcissistic personality disorder are similar to those of other personality disorders. It's possible to be diagnosed with more than one personality disorder at the same time.

To be diagnosed with narcissistic personality disorder, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.

Criteria for narcissistic personality disorder to be diagnosed include:

Having an exaggerated sense of self-importance

Being preoccupied with fantasies about success, power or beauty

Believing that you are special and can associate only with equally special people

Treatments and drugs

Narcissistic personality disorder treatment is centered around psychotherapy. There are no medications specifically used to treat narcissistic personality disorder. However, if you have symptoms of depression, anxiety or other conditions, medications such as antidepressants or anti-anxiety medications may be helpful.

Types of therapy that may be helpful for narcissistic personality disorder include:

Family therapy. Family therapy typically brings the whole family together in therapy sessions. You and your family explore conflicts, communication and problem solving to help cope with relationship problems.

Group therapy. Group therapy, in which you meet with a group of people with similar conditions, may be helpful by teaching you to relate better with others. This may be a good way to learn about truly listening to others, learning about their feelings and offering support.

Because personality traits can be difficult to change, therapy may take several years. The short-term goal of psychotherapy for narcissistic personality disorder is to address such issues as substance abuse, depression, low self-esteem or shame. The long-term goal is to reshape your personality, at least to some degree, so that you can change patterns of thinking that distort your self-image and create a realistic self-image.

Psychotherapy can also help you learn to relate better with others so that your relationships are more intimate, enjoyable and rewarding. It can help you understand the causes of your emotions and what drives you to compete, to distrust others, and perhaps to despise yourself and others.

Lifestyle and home remedies

Whether you decide to seek treatment on your own or are encouraged by loved ones or a concerned employer, you may feel defensive about treatment or think it's unnecessary. The nature of narcissistic personality disorder can also leave you feeling that the therapy or the therapist is not worth your time and attention, and you may be tempted to quit. Try to keep an open mind, though, and to focus on the rewards of treatment.

Also, it's important to:

Stick to your treatment plan. Attend scheduled therapy sessions and take any medications as directed. Remember that it can be hard work and that you may have occasional setbacks.

Learn about it. Educate yourself about narcissistic personality disorder so that you can better understand symptoms, risk factors and treatments.

Get treatment for substance abuse or other mental health problems. Your addictions, depression, anxiety and stress can feed off each other, leading to a cycle of emotional pain and unhealthy behavior.

Learn relaxation and stress management. Try such stress-reduction techniques as meditation, yoga or tai chi. These can be soothing and calming.

Stay focused on your goal. Recovery from narcissistic personality disorder can take time. Keep motivated by keeping your recovery goals in mind and reminding yourself that you can work to repair damaged relationships and become happier with your life.

Prevention

Because the cause of narcissistic personality disorder is unknown, there's no known way to prevent the condition with any certainty. Getting treatment as soon as possible for childhood mental health problems may help. Family therapy may help families learn healthy ways to communicate or to cope with conflicts or emotional distress. Parents with personality disorders may benefit from parenting classes and guidance from therapists or social workers.